TV Broadcaster Relocation Fund Reimbursement Application

Applicant Information

Applicant Name, Type, and Contact Information

Applicant	Address	Phone	Email	Applicant Type
FOX TELEVISION STATIONS, LLC	Ann West Bobeck 101 Constitution Avenue Suite 200 West WASHINGTON, DC 20001 United States	+1 (202) 824-6503	ann.bobeck@fox.com	Limited Liability Company

Applicant

Address

Phone

Applicant Type

FOX TELEVISION STATIONS, LLC

Ann West Bobeck

101 Constitution Avenue

Suite 200 West

WASHINGTON, DC 20001

United States

+1 (202) 824-6503

ann.bobeck@fox.com

Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant	Address	Phone	Email
[Confidential]

Preparer Contact Information

Preparer Contact Name and Information

Applicant	Address	Phone	Email
Dennis Wallace Managing Partner Meintel, Sgrignoli & Wallace, LLC	Dennis Wallace 1282 Smallwood Drive Suite 372 Waldorf, MD 20603 United States	+1 (202) 251-7589	Dennis.Wallace@mswdtv.com

Applicant

Address

Phone

Dennis Wallace

Managing Partner

Meintel, Sgrignoli & Wallace, LLC

Dennis Wallace

1282 Smallwood Drive

Suite 372

Waldorf, MD 20603

United States

+1 (202) 251-7589

Dennis.Wallace@mswdtv.com

Broadcaster Information and Transition Plan

Question	Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information.	No
Briefly describe transition plan	Replace current top mount antenna and TX line Replace current transmitter Due to anticipated delays the Main antenna may need to be changed post P7. KZJO will need to operate on Interim antenna longer than initially planned.

Transmitters

Section	Question	Response
Transmitter Related Expenses	Do you have transmitter related expenses?	Yes

Auxiliary Transmitter

Add Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Auxiliary (Backup)
	Description of Use	Auxiliary
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	Elite
	Year	2010
	Type	Solid State
	Solid State Cooling	Air Cooled
	Solid State Power Capacity	9 kW

Auxiliary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Auxiliary (Backup)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Manufacturer
	Model	ULXTE-10
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	6.2 kW
	Justification for New Transmitter	Thompson transmitter is not re-tunable or supported.

Auxiliary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	No
	Switchgear (industrial 800 amp)	No
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	No
	Size	N/A
	Length	N/A
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Field Engineering - Aux	Field evaluation, electrical of Aux transmitter as required by state

Primary Transmitter

Existing Transmitter Information

Section	Question	Response
Existing Transmitter Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is this transmitter currently shared with another station?	No
	Is this transmitter currently in operating condition?	Yes
Existing Transmitter Manufacturer and Type	Manufacturer
	Model	DCX-2
	Year	2000
	Type	Inductive Output Tube
	IOT Power Type	Two
	Power Capacity	50 kW

Primary Transmitter

New Transmitter Costs

Section	Question	Response
New Transmitter	Use	Primary (Main)
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Manufacturer
	Model	ULXTE-120
	Transmitter Type	Solid State
	Solid State Cooling	Liquid Cooled
	Solid State Power capacity	76 kW
	Justification for New Transmitter	The current transmitter is not re-tunable as state by the manufacturer. ULXTE-120 is the required size with or with our E-pole.

Primary Transmitter

Other Transmitter Costs

Section	Question	Response
Electrical Service	Service Entrance (3 phases 800A 208V)	Yes
	Switchgear (industrial 800 amp)	Yes
	Transformer (480V)	No
	Power	N/A
	Rigid Conduit and Wiring	Yes
	Size	2 inches
	Length	200.0 feet
	Other Electrical Service	No
	Description	N/A
HVAC Service	Does the replacement transmitter require HVAC Service?	No
	Type	N/A
	Size	N/A
	Other Size	N/A
Transmitter Building Addition/Modification or Leasehold Improvement	Does the Transmitter Building require an addition, modification, other leashold improvement?	No
	Size	N/A
Channel 14 Costs	Is an RF Consulting Engineer needed?	N/A
	Is a channel 14 Mask Filer needed?	N/A
	Is additional field engineering time needed?	N/A
	Number of Days	N/A

Primary Transmitter

Other Transmitter Cost Not Listed

Name	Description
Electrical work	Install panels, xfmr, power, etc. to xmtrs
Field Engineering - Transmitter	Field Engineer onsite
HVAC	Fresh air hood for new transmitters
Water line	Had to move waterline for new transmitters
Field Evaluation of Transmitter	Field eval and inspection of transmitter

Antennas

Section	Question	Response
Antenna Related Expenses	Do you have antenna related expenses?	Yes

Primary Antenna

Existing Antenna Information

Section	Question	Response
Existing Antenna Description	Type of change	Purchase New
	Antenna Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing antenna shared with another station or stations?	No
	Is the existing antenna directional?	No
	Is antenna in operating condition?	Yes
	Is antenna located on or in close proximity to an antenna farm?	No
Existing Antenna Manufacturer and Type	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels	N/A
	Design power capacity in use	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU20-GTH 04
	Year	2001

Primary Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	Yes
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	No
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Types	Class	Full Power
	Mounting	Top Mount
	Antenna position in stack	Not in Stack
	Polarization	Elliptical
	Type	Slotted Coaxial
	Number of Stations Supported	N/A
	Number of Panels/Bays	N/A
	Lower Limit	N/A
	Upper Limit	N/A
	Design power capacity in use	N/A
	Other Antenna Type	N/A
	ERP:	1000.0 kW
	Manufacturer
	Model	TFU-22JTH/VP-R 04
	Year	2019
	Justification for New Antenna	Current antenna will not work on assigned channel

Primary Antenna

Other Antenna Costs

Section	Question	Response
Combiner for Shared Antenna	Do you need a Combiner for a Shared Antenna?
	Type
	Number of channels supported	N/A
	Frequencies of channels supported	N/A
	Frequency	N/A
	Do you need a combiner output splitter/switcher for dual feed lines?	N/A
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	Single Channel
	Feed Line Size	7 3/16 inches inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Primary Antenna

Other Antenna Cost Not Listed

Name	Description
Feed through	Elbow complex to antenna connection 6" line
Tax	Washington State Taxes
Elbows	Elbow 8-75 EIA DIGIT 12x24
Bird Cage	Antenna Mounting adapter (wedding cake)

Interim Antenna

New Antenna Costs

Section	Question	Response
New Antenna Description	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Ownership	Owned
	Owner	N/A
	Is antenna shared?	No
	Is antenna directional?	Yes
	Will antenna be located on or in close proximity to an antenna farm?	No
New Antenna Manufacturer and Type	Class	Full Power
	Mounting	Side Mount
	Antenna position in stack	Not in Stack
	Polarization	Horizontal
	Type	Broadband Slot
	Number of Stations Supported	1
	Number of Panels/Bays	8
	Lower Limit	470.00 MHz
	Upper Limit	602.00 MHz
	Design power capacity in use	25.0 %
	Other Antenna Type	N/A
	ERP:	200.0 kW
	Manufacturer
	Model	TFU-WB16
	Year	2019
	Justification for New Antenna	Interim antenna to stay on the air during transition

Interim Antenna

Other Antenna Costs

Section	Question	Response
Elbow Complex	Do you require the separate purchase of the Elbow Complex?	Yes
	Broadband or Single Channel?	B
	Feed Line Size	6 1/8 inches
Side Mount Brackets	Do you require the separate purchase of side mount brackets for an antenna?	Yes
Pattern Scatter Analysis	Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna?	No
Sweep Test	Do you require the sweep testing of transmission line and antenna?	Yes

Interim Antenna

Other Antenna Cost Not Listed

Information not provided.

Transmission Line

Section	Question	Response
Transmission Line Related Expenses	Do you have transmission line related expenses?	Yes

Primary Transmission Line

Existing Transmission Line

Section	Question	Response
Existing Transmission Line Description	Type of change	Purchase New
	Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Owner	N/A
	Site	N/A
	Is the existing transmission line shared with another station or stations?	No
	Is Transmission Line in operating condition?	Yes
Existing Transmission Line Manufacturer and Type	Manufacturer
	Type	Rigid
	Diameter	6 1/8 inches
	Other Diameter	N/A
	Segment Length	19 1/2 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	737 feet per run

Primary Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Primary (Main)
	Description of Use	N/A
	Change Type	Purchase New
	Is this a request for upgraded equipment?	No
	Type	Rigid
	Diameter	8 3/16 inches
	Other Diameter	N/A
	Segment Length	20 inches
	Other Segment Length	N/A
	Number of parallel runs	1
	Length	737 feet per run
	Justification for New Transmission Line	Current line is not the correct section length

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Interim Transmission Line

New Transmission Line

Section	Question	Response
New Transmission Line Costs	Use	Interim
	Description of Use	N/A
	Change Type	Purchase New
	Type	Rigid
	Diameter	6 1/8 inches
	Segment Length	19 ¾ '
	Other Segment Length
	Number of parallel runs	1
	Length	575 feet per run
	Justification for New Transmission Line	To feed interim antenna

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Information not provided.

Tower Equipment And Rigging Costs

Section	Question	Response
Tower Equipment or Rigging Costs Changes	Do you have tower equipment or rigging costs changes?	Yes

Primary Tower

Existing Tower

Section	Question	Response
Existing Tower Description	Type of change	Modify Existing
	Tower Use	Primary (Main)
	Description of Use	N/A
	Ownership	Owned
	Is this tower consider Complex?	Terrain Constrained
	Is this tower currently shared with any other stations?	No
	One or more FM, AM or TV radio broadcaster(s)	N/A
	Others Types of Users	N/A
	Is tower documented for structural analysis?	Yes
	Is tower compliant with Rev G?	Yes
Existing Tower Structure Registration	Do you have a tower registration number?	Yes
Existing Tower Structure Registration	ASR Number	1226015
Coordinates (NAD83)	Latitude (NAD83)	47° 36' 56.3" N-
	Longitude (NAD83)	122° 18' 30.4" W-
	Overall Structure Height	682.08 feet
	Support Structure Height	569.87 feet
	Ground Elevation Above Mean Sea Level (AMSL)	410.10 feet
	Structure Type	TOWER - Free Standing or Guyed Structure
	Tower Owner	Tribune Broadcasting Seattle, LLC
	Date Constructed	07/10/2001

Primary Tower

Tower Modification Costs

Section	Question	Response
Engineering Study	Please what type of engineering study is required, if any:	Study needed for undocumented/poorly documented tower
Tower Reinforcements	Please select whether tower reinforcements are needed:	Minor Reinforcements needed

Primary Tower

Tower Rigging Costs

Section	Question	Response
Tower Rigging Costs	Complex Tower	Terrain constrained
Helicopter Services Required	Are helicopter services required?	No

Primary Tower

Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

Section	Question	Response
Outside Project Management Services	Do you require outside project management services?	Yes
	Number of Hours	400
	Explanation	Outside management of the project
Outside RF consulting Engineering Services	Perform engineering study for new channel assignment and antenna development	Yes
	Prepare engineering section of Form FCC Construction Permit Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare engineering section of Form FCC License to Cover Application	Yes
	For Auxiliary Facility	No
	For Main Facility	Yes
	Prepare request for Special Temporary Authority	Yes
	Quantity	2
	Do you have Distributed Transmission System engineering services?	N/A
	Critical Facility	N/A
	Terrain-Shielded Facility	N/A
Attorney and Other Outside Consulting Services	Prepare and file Form FCC Construction Permit Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare and file Form FCC License to Cover Application	No
	For Auxiliary Facility	N/A
	For Main Facility	N/A
	Prepare request for Special Temporary Authority	No
	Quantity	N/A
	NEPA Section 106 environmental review	No
	Environmental Assessment	No
	ASR Modification	No
	FAA Consultation (including preparation of FAA Form 7460)	No
	Negotiation of Lease and other Matter for Shared Locations	No
	Prepare or Review FCC Form 399 for Reimbursement	No
	Address transition timing and coordination issues w/ other stations and wireless providers	No
RF Field Engineering Services	Comprehensive coverage verification via field study	No
	RF exposure measurements	Yes
	Additional Field Engineering Service	No
	Number of Days	N/A
	Justification	N/A

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Information not provided.

Other Expenses

Section	Question	Response
AM Pattern Disturbance	Is an Impact Study needed?	No
AM Pattern Disturbance	Is Remediation needed?	No
Facility Expenses	Name	N/A
	Other Distributed Transmission System Expenses Not listed	N/A
	Name	N/A
	Is Notification of a Medical Facility required as a result of DTV broadcasting?	Yes
Permit and Filing Costs	Local Zoning	Yes
	Non-zoning permits	Yes
	BLM or NFS Coordination	No
	FCC Construction Permit Minor Change	Yes
	FCC License to Cover Application	Yes
	FCC Special Temporary Authority Application	Yes
Other Miscellaneous Expenses	Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)?	Yes
	Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs?	Yes
	Does this relocation require Equipment Storage?	Yes
	Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change?	Yes
	Does this relocation require MVPD Notification of a Channel Change?	Yes

Other Expenses

Other Expenses Not Listed

Name	Description
Security	Security costs for the tower site
Rental fees	Barricade sign rentals, etc

Cost Information

Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$2,509,435.20	$2,476,135.20	N/A	$2,316,269.83	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Primary Transmitter ULXTE-120	$2,233,335.20	$2,230,535.20		$2,126,445.48
Field Evaluation of Transmitter	$2,400.00	$2,400.00	Field evaluation of transmitter	$2,400.00	N/A
Water line	$2,587.35	$2,587.35	N/A	$2,587.35	N/A
HVAC	$14,147.85	$14,147.85	install fresh air hoods for new transmitters	$14,147.85	N/A
Field Engineering - Transmitter	$6,400.00	$6,400.00	Field engineer onsite for transmitter	$6,400.00	N/A
Electrical work	$160,000.00	$160,000.00	N/A	$159,809.05	N/A
UHF - Liquid Cooled Solid State Transmitter 76 kW	$1,990,000.00	$1,990,000.00	N/A	$1,921,283.23	N/A
2" Rigid Conduit and Wiring (Cost per foot)	$5,200.00	$5,000.00	N/A	N/A	N/A
Service entrance 3 phase/800 amp/208 volt	$14,400.00	$13,700.00	N/A	N/A	N/A
Switchgear - industrial 800 amp	$38,200.00	$36,300.00	N/A	$19,818.00	N/A
Auxiliary Transmitter ULXTE-10	$276,100.00	$245,600.00		$189,824.35
Field Engineering - Aux	$2,600.00	$2,600.00	N/A	$2,600.00	N/A
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	$273,500.00	$243,000.00	N/A	$187,224.35	N/A

Components

Actual Information Description	File Name
Field Evaluation of Transmitter	Component Description: Field Eval of Gates Air Transmitter per WA state requirements Amount: $2,400.00
Water line	Component Description: Had to move waterline for new KZJO transmitter Amount: $2,587.35
HVAC	Component Description: Final billing - fresh air hoods for new KZJO transmitter Amount: $7,541.85 Component Description: Progress payment on fresh air hoods for HVAC. Amount: $6,606.00 Component Description: progress billing - fresh air hoods for new KZJO transmitter Amount: $6,606.00
Field Engineering - Transmitter	Component Description: One field engineer onsite for one day for transmitter. Amount: $6,400.00 Component Description: Sweep Amount: $6,400.00
Electrical work	Component Description: electrical work Amount: $62,757.00 Component Description: final invoice Amount: $97,052.05
UHF - Liquid Cooled Solid State Transmitter 76 kW	Component Description: ULXTE-120 2nd payment Amount: $571,106.09 Component Description: 4th payment - ULXTE-120 Amount: $102,184.62 Component Description: payment ULXTE-120 Amount: $676,886.43 Component Description: deposit for ULXTE-120 Amount: $571,106.09 Component Description: certification label on primary transmitter ULXTE-120 Amount: $2,400.00
2" Rigid Conduit and Wiring (Cost per foot)	Information not provided.
Service entrance 3 phase/800 amp/208 volt	Information not provided.
Switchgear - industrial 800 amp	Component Description: 12% completion on electrical work Amount: $19,818.00
Field Engineering - Aux	Component Description: Field Eval of transmitter Amount: $2,600.00 Component Description: Field evaluation of aux transmitter, as required by state Amount: $2,600.00
UHF - Liquid Cooled Solid State Transmitter 4.9 . 6.5 kW	Component Description: payment ULXTE-10 Amount: $34,873.71 Component Description: ULXTE-10 Amount: $44,929.84 Component Description: certification label on aux transmitter ULXTE-10 Amount: $2,600.00 Component Description: ULXTE-10 2nd payment Amount: $53,710.40 Component Description: deposit ULXTE-10 Amount: $53,710.40

Cost Information

Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$603,170.00	$433,220.00	N/A	$311,220.70	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Interim Antenna TFU-WB16	$233,080.00	$171,360.00		$110,692.79
Side mount brackets for high power antennas (if not included in antenna base cost)	$23,150.00	$12,000.00	N/A	$6,986.26	N/A
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	$13,700.00	$12,960.00	N/A	$0.00	N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized	$189,500.00	$140,000.00	N/A	$97,306.53	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$6,400.00	N/A
Primary Antenna TFU-22JTH/VP-R 04	$370,090.00	$261,860.00		$200,527.91
Elbows	$12,960.00	$12,960.00	N/A	$12,960.00	N/A
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed)	$13,900.00	$13,500.00	N/A	$12,224.70	N/A
Sweep test of existing antenna	$6,730.00	$6,400.00	N/A	$5,760.00	N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	$289,500.00	$182,000.00	N/A	$131,787.00	N/A
Tax	$5,000.00	$5,000.00	N/A	$2,483.59	N/A
Feed through	$22,000.00	$22,000.00	N/A	$18,815.62	N/A
Bird Cage	$20,000.00	$20,000.00	N/A	$16,497.00	N/A

Components

Actual Information Description	File Name
Side mount brackets for high power antennas (if not included in antenna base cost)	Component Description: Mounts - deposit Amount: $3,493.13 Component Description: Mounts - 2nd payment Amount: $3,493.13
Elbow complex, broadband, at antenna input, per 6 1/8. feedline (if needed)	Component Description: elbow 8-75 Amount: N/A
UHF - Lower Power Side Mount, One station - 200-500 kW, horizontally polarized	Component Description: monies applied here because of zero balance invoice. Amount: $5,574.03 Component Description: TFU-16WB C16 - Deposit Amount: $45,866.25 Component Description: TFU-16WB C16 - 2nd payment Amount: $45,866.25
Sweep test of existing antenna	Component Description: Sweep test - deposit Amount: $2,880.00 Component Description: Sweep test - 2nd payment Amount: $2,880.00 Component Description: sweep test Amount: $640.00
Elbows	Component Description: Elbows Amount: $12,960.00
Elbow complex, single channel, at antenna input, per 7 3/16. feedline (if needed)	Component Description: Elbow complex - deposit Amount: $6,112.35 Component Description: Elbow complex Amount: $6,112.35
Sweep test of existing antenna	Component Description: Sweep test - deposit Amount: $2,880.00 Component Description: Sweep test Amount: $2,880.00
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized	Component Description: TFU-22JTH/VP-R 06 - Deposit Amount: $65,893.50 Component Description: TFU-22JTH/VP-R 06 Amount: $65,893.50
Tax	Component Description: Washington State Taxes Amount: $465.41 Component Description: Washington State Taxes Amount: $467.02 Component Description: Washington State Taxes Amount: $180.29 Component Description: Sales tax on Dielectric Invoice #682016, transmission line shipping. Amount: $1,370.87 Component Description: Sales Tax on invoice 592019 Amount: $369.68 Component Description: Washington State Taxes Amount: $1,370.87 Component Description: Washington State Taxes Amount: $369.68
Feed through	Component Description: FEED THROUGH Amount: $9,407.81 Component Description: feed through - deposit Amount: $9,407.81
Bird Cage	Component Description: Birdcage - deposit Amount: $8,248.50 Component Description: BIRDCAGE Amount: $8,248.50

Cost Information

Transmission Line

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$371,889.00	$329,000.00	N/A	$286,644.40	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Interim Transmission Line	$116,150.00	$145,000.00		$103,595.60
Rigid Transmission Line - copper, 6 1/8"	$116,150.00	$145,000.00	N/A	$103,595.60	N/A
Primary Transmission Line	$255,739.00	$184,000.00		$183,048.80
Rigid Transmission Line - copper, 8 3/16"	$255,739.00	$184,000.00	N/A	$183,048.80	N/A

Components

Actual Information Description	File Name
Rigid Transmission Line - copper, 6 1/8"	Component Description: Transmission line - 2nd payment Amount: $48,978.68 Component Description: Rigid Transmission Line Amount: $2,324.00 Component Description: TLSCR'S - Deposit Amount: $1,657.12 Component Description: transmission line - deposit Amount: $48,978.68 Component Description: Rigid transmission line Amount: $2,324.00 Component Description: TLSCR'S - Deposit Amount: $1,657.12
Rigid Transmission Line - copper, 8 3/16"	Component Description: 4 cut pieces Amount: $4,608.00 Component Description: cut piece needed to make deadline Amount: $4,648.00 Component Description: TLSCR 7/75 1 @ 15.750 inches Amount: $1,785.00 Component Description: transmission line - deposit Amount: $80,554.50 Component Description: 2 cut pieces Amount: $4,624.00 Component Description: TLSCR'S Amount: $3,137.40 Component Description: transmission line Amount: $80,554.50 Component Description: TLSCR'S - Deposit Amount: $3,137.40

Actual Information Description

File Name

Rigid Transmission Line - copper, 6 1/8"

Component Description:: Transmission line - 2nd payment
Amount:: $48,978.68

Component Description:: Rigid Transmission Line
Amount:: $2,324.00

Component Description:: TLSCR'S - Deposit
Amount:: $1,657.12

Component Description:: transmission line - deposit
Amount:: $48,978.68

Component Description:: Rigid transmission line
Amount:: $2,324.00

Component Description:: TLSCR'S - Deposit
Amount:: $1,657.12

Rigid Transmission Line - copper, 8 3/16"

Component Description:: 4 cut pieces
Amount:: $4,608.00

Component Description:: cut piece needed to make deadline
Amount:: $4,648.00

Component Description:: TLSCR 7/75 1 @ 15.750 inches
Amount:: $1,785.00

Component Description:: transmission line - deposit
Amount:: $80,554.50

Component Description:: 2 cut pieces
Amount:: $4,624.00

Component Description:: TLSCR'S
Amount:: $3,137.40

Component Description:: transmission line
Amount:: $80,554.50

Component Description:: TLSCR'S - Deposit
Amount:: $3,137.40

Cost Information

Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$605,300.00	$562,794.25	N/A	$479,778.65	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Primary Tower TOWER	$605,300.00	$562,794.25		$479,778.65
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	$26,300.00	$25,500.00	N/A	$23,800.00	N/A
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	$421,000.00	$406,000.00	N/A	$405,608.40	N/A
Minor tower reinforcement/modifications	$158,000.00	$131,294.25	N/A	$50,370.25	Previous 2 invoices were rejected but are counting towards sub-total

Components

Actual Information Description	File Name
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study	Component Description: Engineering costs Amount: $3,168.00 Component Description: Rigging plan analysis Amount: $3,375.00 Component Description: Engineering costs Amount: $2,437.50 Component Description: drawings and specs Amount: $718.75 Component Description: Tower mapping for KZJO only Amount: $6,055.00 Component Description: Tower mapping and observation Amount: $6,055.00 Component Description: Drawings and specs Amount: $1,375.00 Component Description: Engineering costs Amount: $6,055.50 Component Description: Engineering costs Amount: $1,125.00 Component Description: Engineering costs Amount: $352.00 Component Description: drawings and specs Amount: $3,406.25 Component Description: Engineering project management for tower work Amount: $1,250.00 Component Description: Engineering costs Amount: $3,375.00 Component Description: Engineering costs Amount: $1,912.50
Complex Tower (includes, for example, those with candelabras and/or stacked antennas)	Component Description: rigging costs Amount: $213,373.80 Component Description: deposit for rigging costs Amount: $185,628.60 Component Description: weather days Amount: $6,606.00
Minor tower reinforcement/modifications	Component Description: Tower and antenna work for antenna install Amount: $50,370.25 Component Description: Tower work for antenna and transmission install Amount: $50,370.75 Component Description: Tower and antenna work for antenna install Amount: $66,885.75

Cost Information

Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$100,445.00	$94,500.00	N/A	$12,371.07	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Outside Professional Services	$100,445.00	$94,500.00		$12,371.07
Prepare request for Special Temporary Authorization	$4,100.00	$3,000.00	N/A	$1,000.00	N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	$1,580.00	$1,500.00	N/A	$500.00	N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	$3,155.00	$3,000.00	N/A	N/A	N/A
Perform engineering study for new channel assignment and antenna development	$7,360.00	$7,000.00	N/A	N/A	N/A
Project management of the transition	$63,200.00	$60,000.00	N/A	$10,871.07	N/A
RF Exposure Measurements	$21,050.00	$20,000.00	N/A	N/A	N/A

Components

Actual Information Description	File Name
Prepare request for Special Temporary Authorization	Component Description: Engineering consulting on STA request Amount: $375.00 Component Description: Engineering consulting for STA request Amount: $625.00
Prepare engineering section of FCC Form 2100 (main), License to Cover Application	Component Description: Engineering consulting engineering part of license to cover CP Amount: $500.00
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application	Information not provided.
Perform engineering study for new channel assignment and antenna development	Information not provided.
Project management of the transition	Component Description: Project Management Amount: $380.00 Component Description: Project Management Amount: $3,580.54 Component Description: Project Management Amount: $475.00 Component Description: Project management Amount: $1,250.00 Component Description: engineering consulting Amount: $95.00 Component Description: pre and post construction site visits Amount: $2,000.00 Component Description: pre and post site visits Amount: $750.00 Component Description: Project Management Amount: $95.00 Component Description: Project management Amount: $1,250.00 Component Description: Project Management Amount: $2,150.53 Component Description: Project Management Amount: $95.00 Component Description: Project Management Amount: $95.00
RF Exposure Measurements	Information not provided.

Cost Information

Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).

Description	Predetermined Cost Estimate	Estimated Cost	Estimated Cost Justification	Actual Cost	Actual Cost Justification
Sub-total	$207,171.90	$206,566.90	N/A	$136,710.07	N/A
Total for all systems	$4,397,411.10	$4,102,216.35	N/A	$3,542,994.72	N/A
Other Expenses	$207,171.90	$206,566.90		$136,710.07
Disposal Costs (for equipment and other waste, net of any salvage value)	$25,000.00	$25,000.00	N/A	$3,746.55	N/A
Rental fees	$153.75	$153.75	Barricade sign rentals	$153.75	N/A
Security	$31,728.15	$31,728.15	N/A	$31,728.15	N/A
MVPD Notification of Channel Change	$11,000.00	$11,000.00	N/A	N/A	N/A
Develop and air announcement of upcoming channel change	$0.00	$0.00	N/A	N/A	N/A
Equipment Storage	$25,000.00	$25,000.00	N/A	$13,946.50	N/A
Equipment Delivery and Handling Charges	$76,100.00	$76,100.00	N/A	$76,083.12	N/A
FCC Filing Fees - Special Temporary Authorization request	$195.00	$190.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 license to cover application	$335.00	$325.00	N/A	N/A	N/A
FCC Filing Fees - Form 2100 minor change CP application	$1,110.00	$1,070.00	N/A	N/A	N/A
Local Zoning	$10,000.00	$10,000.00	N/A	$0.00	N/A
DTV Medical Facility Notification	$11,550.00	$11,000.00	N/A	$3,750.00	N/A
Non-zoning permits	$15,000.00	$15,000.00	N/A	$7,302.00	N/A

Components

Actual Information Description	File Name
Disposal Costs (for equipment and other waste, net of any salvage value)	Component Description: disposal of waste Amount: $1,664.68 Component Description: Waste removal KZJO Transmitter site Amount: $2,081.87 Component Description: disposal of waste Amount: $2,081.87
Rental fees	Component Description: Barricade sign rentals Amount: $153.75
Security	Component Description: security for tower site Amount: $31,728.15
MVPD Notification of Channel Change	Information not provided.
Develop and air announcement of upcoming channel change	Information not provided.
Equipment Storage	Component Description: January 2020 storage charges Amount: $150.00 Component Description: April 2020 storage charges for tower equipment Amount: $150.00 Component Description: Storage fees Amount: $164.00 Component Description: Storage fees Amount: $992.00 Component Description: storage fees Amount: $504.50 Component Description: Dec. storage fees Amount: $150.00 Component Description: Storage fees Amount: $164.00 Component Description: Storage fees Amount: $164.00 Component Description: Storage fees Amount: $206.00 Component Description: Storage fees Amount: $721.00 Component Description: May 2020 Storage charges for tower equipment. Amount: $150.00 Component Description: Storage fees Amount: $206.00 Component Description: Storage Fee Amount: $10,075.00 Component Description: Feb 2020 storage charges Amount: $150.00 Component Description: requesting just storage costs on this invoice Amount: $10,075.00
Equipment Delivery and Handling Charges	Component Description: requesting just freight and shipping on this invoice Amount: $26,352.47 Component Description: Freight and Shipping Amount: $2,917.92 Component Description: equipment rental, delivery Amount: $321.49 Component Description: Delivery fees Amount: $164.00 Component Description: Delivery fees Amount: $748.00 Component Description: Delivery fees Amount: $670.50 Component Description: Freight charges Amount: $17,300.00 Component Description: Equipment Rental Amount: $1,453.32 Component Description: Delivery fees Amount: $1,255.00 Component Description: Delivery charges Amount: $2,798.00 Component Description: Delivery fees Amount: $583.50 Component Description: Equipment Rental Amount: $1,453.32 Component Description: Delivery fees Amount: $658.00 Component Description: Freight and Shipping Amount: $3,798.32 Component Description: Freight Amount: $7,651.24 Component Description: Freight and Shipping Amount: $612.93 Component Description: Equipment Rental Amount: $1,882.71 Component Description: equipment rental Amount: $1,019.18 Component Description: Delivery fees Amount: $583.50 Component Description: Transmission line shipping Amount: $7,651.24 Component Description: Equipment Rental Amount: $663.90 Component Description: delivery charges Amount: $992.00 Component Description: equipment rental Amount: $321.49 Component Description: Delivery fees Amount: $583.50 Component Description: Equipment Rental Amount: $1,453.32 Component Description: Delivery fees Amount: $167.00 Component Description: Equipment rental, delivery Amount: $1,019.18 Component Description: Freight and Shipping Amount: $7,651.24 Component Description: Freight and Shipping Amount: $26,352.47
FCC Filing Fees - Special Temporary Authorization request	Information not provided.
FCC Filing Fees - Form 2100 license to cover application	Information not provided.
FCC Filing Fees - Form 2100 minor change CP application	Information not provided.
Local Zoning	Information not provided.
DTV Medical Facility Notification	Component Description: medical testing Amount: $3,750.00
Non-zoning permits	Component Description: Drawings and Specs required for permits. Labor and costs of fees and permits, City of Seattle. Amount: $5,726.25 Component Description: Permits March 2020 Amount: $417.00 Component Description: City of Seattle permits and fees Amount: $603.25 Component Description: Permits Feb 2020 Amount: $416.50 Component Description: Permits for City of Seattle and labor for permits. Amount: $4,351.25 Component Description: City of Seattle permits Amount: $603.25 Component Description: Barricade and sign rental Amount: $153.75 Component Description: City of Seattle permits Amount: $603.25 Component Description: Permits for month of Jan 2020 Amount: $139.00

Cost Information

Grand Total

	Predetermined Cost Estimate	Estimated Cost	Actual Cost
Total for all systems	$4,397,411.10	$4,102,216.35	$3,542,994.72

Reimbursement Status

Question	Response
The facility has ceased operating on its pre-auction channel.	Yes
Construction of final facilities or all necessary modifications are complete.	No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator.	No

Certification

Section	Question	Response
Submission of Estimated Expenses Statements	WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.
The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD). The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Angelo Servedio SVP Controller 06/14/2021

Section

Question

Response

Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Angelo Servedio

SVP Controller

06/14/2021

Certification

Section	Question	Response
Submission of Actual Cost Documentation Statements	WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).
The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct. The above-named entity acknowledges that all certifications and attached documentation are considered material representations. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) . The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.
I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.	Angelo Servedio SVP Controller 06/14/2021

Section

Question

Response

Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.
The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.
The above-named entity acknowledges that all certifications and attached documentation are considered material representations.
The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.
The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .
The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.
The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.
The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.
The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

Angelo Servedio

SVP Controller

06/14/2021

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Applicant Information

Applicant Name, Type, and Contact Information

Reimbursement Contact Information

Reimbursement Contact Name and Information

Preparer Contact Information

Preparer Contact Name and Information

Broadcaster Information and Transition Plan

Transmitters

Auxiliary Transmitter

Add Transmitter Information

Auxiliary Transmitter

New Transmitter Costs

Auxiliary Transmitter

Other Transmitter Costs

Auxiliary Transmitter

Other Transmitter Cost Not Listed

Primary Transmitter

Existing Transmitter Information

Primary Transmitter

New Transmitter Costs

Primary Transmitter

Other Transmitter Costs

Primary Transmitter

Other Transmitter Cost Not Listed

Antennas

Primary Antenna

Existing Antenna Information

Primary Antenna

New Antenna Costs

Primary Antenna

Other Antenna Costs

Primary Antenna

Other Antenna Cost Not Listed

Interim Antenna

New Antenna Costs

Interim Antenna

Other Antenna Costs

Interim Antenna

Other Antenna Cost Not Listed

Transmission Line

Primary Transmission Line

Existing Transmission Line

Primary Transmission Line

New Transmission Line

Primary Transmission Line

Other Transmission Line Expenses Not Listed

Interim Transmission Line

New Transmission Line

Interim Transmission Line

Other Transmission Line Expenses Not Listed

Tower Equipment And Rigging Costs

Primary Tower

Existing Tower

Primary Tower

Tower Modification Costs

Primary Tower

Tower Rigging Costs

Primary Tower

Other Tower Expenses Not Listed

Outside Professional Services Costs

Outside Professional Services Costs

Other Professional Services Expenses Not Listed

Other Expenses

Other Expenses

Other Expenses Not Listed

Cost Information

Transmitters

Components

Cost Information

Antennas

Components

Cost Information

Transmission Line

Components

Cost Information

Tower Equipment and Rigging Costs

Components